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Selected Publication:
Schwärzer, U.
Postoperative Pain and Risk of Hemorrhage Following Uvulopalatopharyngoplasty With and Without Tonsillectomy - A Retrospective Study
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp.
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- Authors Med Uni Graz:
- Advisor:
- Tomazic Peter Valentin
- Wolf Axel
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- Abstract:
- Introduction: Obstructive sleep apnea syndrome (OSAS) is a disorder with an estimated prevalence of up to 30%. It is characterized by repetitive pharyngeal collapse during sleep and associated with witnessed apneas, snoring, daytime sleepiness and an increased risk for cardiovascular disease. One of the therapeutic options for OSAS is uvulopalatopharyngoplasty (UPPP), usually including tonsillectomy (TE). Main complications after UPPP include secondary hemorrhage and intense pain. The aim of the study was to investigate if pain intensity after surgery correlates with the risk of hemorrhage and if there is a difference in the risk of hemorrhage after UPPP with TE and UPPP without TE. Material and Methods: All patients who had undergone UPPP, expansion sphincter pharyngoplasty (ESP) or coblation assisted uvulopalatoplasty (CAUP) at the Department of Otorhinolaryngology of the Medical University of Graz between 2014 and 2016 were included. Data was collected retrospectively from patients’ records and included demographic data, AHI, surgical procedure, postoperative bleeding episodes, pain levels during hospital stay, analgesic medication and length of hospital stay. Statistical tests were performed to compare the incidence of hemorrhage between different types of surgery and to evaluate the relationship between pain intensity and risk of hemorrhage. A p-value of <0.05 was considered significant. Results: Of all 120 patients included, 78 had undergone UPPP with tonsillectomy, 12 UPPP without tonsillectomy, 22 CAUP, 5 ESP and 3 a combination of ESP and UPPP. 71.7% of all surgeries included the removal of the palatine tonsils. An overall hemorrhage rate of 17.5% (21 patients) was found. If only surgeries that included tonsillectomy were considered, the hemorrhage rate was 24.4%. In 8 cases bleeding stopped without treatment, in 12 cases local therapy and in 9 cases a surgical revision was necessary. None of the patients undergoing a type of surgery without TE had postoperative bleeding. The correlation between tonsillectomy and incidence of secondary hemorrhage was highly significant (p = 0.002). After surgeries including TE postoperative pain intensity was significantly higher than after surgeries which did not include TE. Conclusion: Tonsillectomy appeared as key risk factor for secondary hemorrhage. After snoring or OSAS surgeries that include tonsillectomy, patients should therefore be observed more carefully than if no tonsillectomy is carried out. No significant correlation between pain intensity in the first postoperative days and the risk for hemorrhage was found.